Family Medicine

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The acceptability and efficiency of routine "opt-out" HIV testing in a South African antenatal clinic setting.
(2008) Van Wyk, Erika.; Giddy, Janet.; Roberts, C. B.; Naidoo, S. S.
Background and Objectives The improved uptake of antenatal Opt-out testing has been documented internationally. In South Africa little is known about the efficiency and die acceptability of Opt-out testing. This study compared VCT with Opt-out testing by measuring the efficiency (defined as uptake of testing, number of women identified as HIV positive and consultation duration of the testing approach) and the acceptability to patients and staff. Methodology We conducted a prospective, quasi-experimental equivalent time-samples clinical trial in which we enrolled a consecutive sample of women who presented at die McCord Hospital antenatal clinic from June to August 2006. The study consisted of 2 phases. During the 6 week intervention period women were offered HIV testing with the Opt-out mediod. During die 6 week control period women were offered midwife-provided VCT. Efficiency was measured in each phase, with 150 participants in the VCT arm and 150 in die Opt-out arm. Participants also completed a survey questionnaire. In depth interviews were conducted with 9 purposefully selected participants from each arm. Two focus group discussions were held with staff. The staff focus group findings were followed-up and validated by conducting in-depdi interviews with die staff members who participated in die focus groups 18 mondis later. Results The uptake of HIV testing during the VCT period was 134/150(89.3%) compared to 147/150(98.0%) in die Opt-out period (p<0.001). The percentage of women identified as being HIV positive during the VCT period was 7.33% (11/150) vs. 12.6% (19/150) during the Opt-out period (p=0.133). Time was saved as a decrease in the duration of midwife consultations from 34 min (VCT) to 26 min (Opt-out) was found with p<0.001. Qualitative analysis revealed Opt-out testing to be an acceptable way of testing. Patients found Opt-out emotionally less distressing than VCT (p<0.05). Staff reported that Opt-out decreased the burden on human resources (only one person needed to facilitate the group and shorter consultations) while it identified more women infected with HIV. Conclusion Opt-out testing is significantly more efficient and acceptable than VCT. Opt-out testing should include a group pre-test information session, adequate and ongoing post-test counselling, to be effective and acceptable.
Alcohol use and the availability of supportive services in a white urban community.
(1986) Miller, Atholl Jonathan.
This study identifies the alcohol intaKe patterns of 274 white patients attending an Urban General Practice. The average consumption rate was 6.5 drinKs per person per weeK (d/p/w). 40X of the surveyed group did not consume any alcohol. The drinkers averaged 11 dIp/wo 72X of the males drank and 501: of the females dranK. 4.31: of the population surveyed were drinking more than 28 dIp/wo Marital status made no real difference to consumption rates but unemployment (16 d/p/w) and being a manual labourer (11.7 d/p/w) did. People who had lost either their occupation (11.7 d/p/w) or a close family member (9.3 d/p/w) in the preceeding year had higher than average (6,5 d/p/w) consumption levels and these were increased further if they had identified an alcohol abuser in their family. This study also identifies the useful supportive services available to this particular community and its health care worKers with a brief discussion of the type of service prOVided and method of access to the service. The appendix contains a list of the services with the relevant address. telephone number and where possible the name of a contact person.
An analysis of the use of African traditional medicine by adult patients attending a primary health care clinic in Durban, KwaZulu-Natal.
(2013) Maphophe, T. S.; Naidoo, S. S.
Background: Current evidence indicates that more and more people worldwide are using complementary and alternate medicines. About 80% of people in Africa and Asia have been reported to be using traditional medicines in preference to allopathic medicines.1 Aim: The study intended to evaluate the prevalence and practice of using traditional medicines by a cohort of patients accessing a local state-clinic located in a semi-urban area in KwaZulu-Natal. Methodology: All patients attending the chosen local primary health care clinic in Durban South formed the sample population and a systematic random sampling method was used to determine the study sample. Data were analysed using Statistical Package for Social Sciences (SPSS) -version 19. Results: A total of 299 patients participated in the study. Of these, 224 were female, 73 male and 2 were unspecified. The majority of participants (n=109) were in the age group 20-29 years. The study found that 112(37%) of all participants admitted to the use of African traditional medicines and the majority of these (78%) used them because they expected their illnesses to improve. Conclusion: This study was conducted among Black African study subjects in a predominantly Black African suburb in South Africa; the study results may have been influenced by this bias. A larger study using a bigger and perhaps more diverse study population is recommended to validate the findings shown in the above pilot study.
An audit of the standard of care received by HIV positive patients on ART at a community health centre in KZN.
(2013) Inderjeeth, Nishana.; Naidoo, Kogieleum.
Introduction: South Africa has the highest number of HIV infected individuals in the world.2 The South African government has established National treatment guidelines for HIV positive patients to help ensure quality of care. The success of these guidelines depends on the commitment and level of adherence to them by hospitals and clinics. Aim: A descriptive study evaluating the standard of care received by HIV positive patients was undertaken at a community health centre in KwaDabeka, a semi-urban town in Kwa-Zulu Natal. This was benchmarked against the National ART Guidelines for 2010, which was the national policy at the time this study was undertaken. The objectives were to identify any deficiencies in the care of patients with HIV/AIDS, and to suggest possible solutions as well as to identify a demographic profile of the patients accessing care. Methods: The researcher selected three hundred and sixty patient files using a random process and then analyzed them. This sample size was calculated using a confidence interval of 95% of a total number of six thousand patients. Adult patients using ART for the period of 01 January 2011 until 31 December 2011 were only included. Pregnant patients and children were excluded from the study .The variables analyzed were generated using the pre-initiation, initiation and monitoring recommendations of the National ART Guidelines of 2010. A data sheet was drawn-up consisting of the various variables. This was analyzed using SPSS version 21. Simple descriptive statistics, univariate analysis, and frequency distribution tables were used to analyze the data. Tables, pie charts, and graphs have been used to represent the analyzed data. Results: Females comprised 65% and the mean patient age was 39 years. While the overall patient management was in accordance to the guidelines, there were major areas of con- compliance. These included the more than 80% of patients who did not have: pap smears; nutritional assessments; follow-up Tuberculosis (TB) symptom reviews; and mental health evaluations. In addition, there was a significant delay from obtaining a CD4 count to initiation of therapy of two months or longer in more than 50% of patients. Furthermore, the clinic did not comply with fast –tracking 84.5% of patients who needed to be initiated within two weeks of obtaining a CD4 count. Adverse events due to antiretroviral therapy were reported in approximately 41% of the patients, however, 25% did not have their regimen changed despite having a serious adverse event documented. The incidence of concurrent infection with TB was 32%, however none of the remaining non-infected patients (68%), received Isoniazid prophylaxis. Recommendations: The management of KwaDabeka CHC have significant challenges to overcome in order to optimise their treatment of HIV positive patients. Possible solutions must include access to the National ART Guidelines for all relevant health-care workers, regular medical update programmes on the management of HIV positive patients, and improving resources and relevant procedural skills.
Cannabis use : social risk factors and knowledge of health risks in a sample of adolescents.
(1997) Van Niekerk, Antoinette Elisabeth.; Schlebusch, Lourens.
A study was conducted at a Durban high school which has a mixture of socioeconomic classes and races. All grade 10 pupils present on the day of the study were asked to complete a questionnaire under examination-like conditions. The aim was to determine the prevalence of dagga smoking as well as the pupils' knowledge of the effects and health risks of dagga smoking and the prevalence of associated features such as alcohol use, cigarette smoking and sexual activity. Dagga smoking was found to occur commonly (22.9%) and to be mainly a white male group activity. There was a strong association with cigarette smoking and alcohol abuse and a general lack of knowledge concerning the adverse health effects of dagga smoking. Peer pressure and relief of stress were cited as the commonest reasons for dagga smoking. More information and life skills training is required for this group of students as well as further research into substance abuse related topics in general.
Characteristics of women having first trimester termination of pregnancy in a district/regional hospital in KwaZulu-Natal.
(2011) Ngene, Nnabuike Chibuoke.; Ross, Andrew John.
Introduction: Despite the availability of contraceptives, some women still seek an induced abortion. If these women are known, they can be targeted for intensive contraceptive counseling. An accessible termination of pregnancy health facility can also be provided to those who still wish to have an abortion. Aim: To determine the characteristics of women having first trimester induced termination of pregnancy in Newcastle Provincial Hospital in Amajuba district. Methods: Quantitative retrospective chart review. Seven hundred and fifty eight women had an induced first trimester abortion between 1st January and 31st December 2008 at Newcastle Provincial Hospital. The medical records of 254 were systematically sampled and the data obtained from these medical records were analyzed descriptively. Results: Most women (75%) were aged between 20 and 34 years. The commonest age was 23 years while the mean age was 25.27 years. Two percent were less than 16 years of age. Ninety seven percent of the sample were of African race, 75.6% reported having at least one child alive, 93.3% were single, 70.1% of the women reside in Newcastle sub-district while 19.7% reside outside Amajuba district. Eighty nine percent of the women were not using any contraception before the pregnancy that was terminated. Four (1.6%) women had previously had a termination of pregnancy. Fifty eight percent of the women requested abortion between 9 and 12 weeks of gestation (commonest gestational age was 8 weeks). Seventy four percent of the women were self-referred. Ninety six percent of the women reported having an abortion because of socio-econornic reasons. Only 69.7% disclosed their intention to procure abortion to a second person. Every woman was counseled before her pregnancy was terminated. Conclusions: In our patient population, women who are more likely to have an induced first trimester abortion are: in their twenties; African; single; parous; sexually active and not using any contraceptive; residing in Newcastle sub-district and of poor socioeconomic status. These groups of women should be targeted for intensive contraceptive counseling. The proportion of women who are less than 16 years of age shows that statutory rape is still a challenge in South Africa and deserves more attention. Further study is needed to establish if the location of Newcastle Provincial Hospital is denying women living in other sub-districts in Amajuba (apart from Newcastle sub-district) the opportunity to procure an induced abortion. Such a study will thus guide the place where future termination of pregnancy services may be established in Amajuba.
Cigarette smoking among Indian matriculants at ex-House of Delegates schools in Northern Kwa-Zulu Natal.
(1995) Bayat, Mahomed.; Pillay, Basil Joseph.
A descriptive study of cigarette smoking in a sample of Indian matriculation students was undertaken in Northern Kwa-Zulu Natal in order to establish the prevalence of cigarette smoking; reasons for developing cigarette smoking behaviour; to determine knowledge about and attitudes to cigarette smoking and also to establish students' awareness of antismoking organisations and to make recommendations based on the findings. Data was collected by the researcher who administered questionnaires at various schools previously under the jurisdiction of the House of Delegates, in the towns of Newcastle, Dannhauser, Glencoe and Dundee. There were 55 smokers in the sample (N =326), ie., a prevalence rate of 16,9%. Among the males 52 (36,1%) were smokers and 3 (1,8%) females smoked. Fifty four (98,2%) smokers had commenced smoking above the age of 10 years. Twenty seven (53%) smoked at home and 12 (24%) smoked at school. Experimentation occured among 46 (83,6%) smokers prior to actual smoking with 52 (94,5%) smokers having friends who also smoked. Advertisements influenced 10 (18,2%) smokers while 11 (20%) were influenced by teachers and 9 (16,7%) were influenced by family members. Smokers received more pocket money than non-smokers. More family members of the smokers were also smokers as opposed to non-smokers. Fourty nine (89,1%) smokers believed that smoking was harmful to themselves while 41 (74,5%) said it was also harmful to others. The association between smoking and lung cancer was well known by 49 (90,7%) smokers but the association with heart disease and other cancers was not as well known. There was very little awareness among both smokers and non-smokers about anti-smoking programmes and organisations. Alarmingly there was hardly any formal health education on the dangers of smoking in schools. The conclusions are that the prevalence of cigarette smoking among Indian matriculants in the study area was 16,9% and that teachers, friends, family members and advertisements are influential in cigarette smoking behaviour. There is a need for education on the dangers of smoking in schools; and parents and teachers must take congnisance about smoking at home and in schools.
Dietary factors in overweight adults.
(1986) Smith, R. J.
The often stated inability of many patients to lose weight or maintain weight reduction is a common complaint heard in general practice and the dietary reasons underlying the problem was studied. The study was carried out in a suburban general practice , and it was found that there is a high degree of dietary ignorance and dietary indiscretion in overweight people. This would therefore account in the majority of cases for the claims made by patients that they eat very little and yet cannot lose weight. Overweight/obesity is of multi-factoral aetiology and the dietary aspect plays a major role. Thus recommendations have been made to endeavour to correct the problem at general practice level, by supplying a protocol in an approach to weight control management and at a community level by the introduction of a comprehensive and multifaceted health programme aimed at education and implementation of good dietary behaviour.
Disability grant assessments at Nqutu, Kwazulu-Natal.
(1994) Mhlambi, Sibusiso D. L. A .
No abstract available.
The ethical dilemmas of critical care specialists encountered in the admission of patients with HIV infection to intensive care.
(2012) Naidoo, Kantharuben.; Lalloo, Umesh Gangaram.; Singh, Jerome Amir.
South Africa has one of the fastest growing HIV epidemics in the world with 5.6 million people living with HIV/AIDS. As a consequence of the delayed implementation of the ARV rollout and failure to control the epidemic, the number of people living with HIV/AIDS who seek or need intensive care places a huge burden on precious, expensive and sparse intensive care unit facilities. Critical care specialists are faced with complex challenges when making decisions about the provision of such care. Aim: The aim of the study was to develop best practice criteria for admitting HIV-infected patients to intensive care. Methods: The study was done utilising: 1. A comprehensive literature review of the legal and ethical framework governing such decisions in South Africa and compared with that in different countries, both developed and developing. Further, legal precedents and clinical best practice that could inform policy and practice in South Africa were applied to the decision making process. 2. An audit of ICU beds in South Africa by first making a comprehensive and contemporary review of critical care facilities in South Africa, to place in context the ethical dilemmas faced by critical care specialists in the admission of HIV/AIDS infected patients to intensive care in a resource limited environment. 3. Critical care practitioners’ response to a standardised questionnaire regarding ethical decisions and provision of intensive care to five hypothetical clinical case scenarios. Results: The study showed that: The ICU bed availability in South Africa is limited and the problem is worse in the public sector with widespread variations across the provinces. The lack of skilled staff for ICU is insufficient for our needs in the public sector. For people living with HIV/AIDS, specific variables influence their survival in intensive care. The benefits of anti-retroviral treatment in intensive care are still being debated. Clinical prediction tools should be considered as an aid to clinical judgment on decisions about whom to admit to intensive care. Rational decision making should include central questions such as ‘ whether the patient too ill or too well for ICU care’ and whether there is a reasonable prospect of ‘reversibility of organ-dysfunction’? Non-invasive ventilation using a continuous positive airway pressure (CPAP) ventilation mask is showing promise for patients with Pneumocystis jeroveci pneumonia (PJP), especially in a resource-constrained environment. Further studies need to validate this. People living with HIV/AIDS are not discriminated against on admissions to ICU and are not subjected to medical futility decisions. Discussion: The shortage of ICU beds results in critical care specialists being under pressure to deliberate on resource allocation decisions for competing patients. Strong regulatory and ethical frameworks exist to protect the rights of people living with HIV/AIDS and access to intensive care. The ‘Limitation Clause’ of the South African Constitution, as canvassed by the courts resulting in the refusal of renal dialysis in the case of Mr. Subramoney, a utilitarian judgment, would not be justiciable for people living with HIV/AIDS and access to intensive care. The National Health Insurance Plan envisages making more ICU beds available through a public-private sector partnership. There is a compelling need for regionalisation of intensive care services in the country. Respiratory failure in HIV/AIDS patients remains the commonest indication for intensive care unit admissions, and other diagnosis such as non-PCP pneumonia, sepsis, cardiac, gastrointestinal, and renal diseases, are becoming more common. The ART era has seen an improvement in ICU to ward survival rates of 70% (similar to that of the general medical population) as well as the three month and long-term survival outcomes post-ICU discharge. ICU prognostic systems should be regarded as an aid to clinical judgment. Daniels ‘accountability for reasonableness’ provides a moral framework for ethical decision-making and priority setting. In its determined efforts to control the pandemic of HIV/AIDS, some countries, notably Botswana and South Africa are accused of violating international treaties. Conclusion: South Africa has made many legal provisions to protect the rights of its HIV infected patients. People living with HIV/AIDS are neither discriminated against in admission to intensive care units, nor being subjected to medical futility decisions. With the advent of HAART, people living with HIV/AIDS admitted to ICUs, have similar outcomes to that of the general population. Admission guidelines for ICU as advised by the professional bodies for use by the general population should be equally applicable to people living with HIV/AIDS, i.e. is the patient too ill or too well to warrant ICU admission, and is there a realistic prospective of 'reversibility of organ dysfunction'?
The experience of anxiety and depression and their sequelae in breast cancer patients: effects of disease and treatment on patient self-esteem, body image, and the prevalence of hopelessness and suicidal ideation.
(2021) Van Oers, Helena.; Schlebush, Lourens.; Gaede, Bernard Martin.
Breast cancer continues to be one of the most commonly diagnosed cancers worldwide. Research suggests that the psychological needs of these patients are frequently unobserved and untreated as healthcare professionals may be insufficiently familiar with the prevalence of comorbid psychological features such as anxiety and depression and how these influence the experience of other psychological phenomena. The aim of this research was to examine the psychological effects of disease and treatment in women diagnosed with breast cancer and determine if these effects differed from those experienced by women with other cancers. While psychological distress in the form of depression and anxiety is well-documented in the literature, there is less specific reference to how these affect and mediate other concerns patients may experience during diagnosis and adjuvant treatment, namely the insult to body image and self-esteem through surgery and other treatment modalities and how these effects cumulatively inform the patient’s experience of hopelessness and possibly, suicidal ideation (SI). The aim was to identify if these forms of distress correlate, and to what degree, with a view to highlighting for oncology healthcare professionals the need to identify and treat those patients who are psychologically at risk. The samples of women with breast cancer (n=80) and other forms of cancer (n=80) was drawn from a population of outpatients receiving treatment at three private oncology clinics in the Durban, South Africa area. Convenience sampling was used and a battery of four questionnaires was completed by patients in addition to collection of relevant demographic data. The results suggest similarities and differences between the two groups. Whilst the two groups did not exhibit notable differences in overall levels of depression and self-esteem, there were significant differences in the experience of body image, with the breast group experiencing greater body image dysphoria. Likewise, in relation to stress, although both groups demonstrated elevated levels of stress in comparison to norms, the breast group evinced higher scores on psychological and behavioural responses to stress. These results suggest that breast cancer patients experience distress differently to patients with other forms of cancer, which may indicate areas for future research.
An exploration of anaemia in low birth weight infants exposed to perinatal zidovudine at the neonatal unit in King Edward VIII Hospital.
(2013) Hanley, Sherika.; Ross, Andrew John.; Adhikari, Miriam.
Large clinical trials beginning with the PACTG-076 trial and other trials across Europe and America have showed that perinatal exposure to Zidovudine (AZT) results in haematological side effects in the neonate, mainly anaemia, which are clinically insignificant and reversible. There is however limited data in sub-Saharan Africa on the impact of intrauterine exposure to AZT on neonates, particularly low birth weight neonates, at the height of the HIV/PMTCT era. The aim of the study was to evaluate the prevalence and clinical significance of anaemia among low birth weight neonates, in a diverse South African setting. This observational descriptive study looked at medical records of HIV-exposed, low-birth weight neonates (less than 2500g) admitted to the neonatal unit at King Edward VIII Hospital from May 2008 to February 2010, who have had intrauterine exposure to AZT. A total of 95 neonatal birth and medical records were analysed. The total prevalence of anaemia was 47%. The neonates were placed into categories according to gestational age. The prevalence of anaemia was 16.7% and the mean Hb was 17g/dL in the 26-28 week gestational age category, prevalence of anaemia was 37% and mean Hb was 16g/dL in the 29-31 week category, and the prevalence of anaemia was 54.8% with a mean of 17g/dL in the over 31 week gestational age category. The minimum haemoglobin was 11.0g/dL and maximum haemoglobin was 24g/dL. The mean haemoglobin in the neonates exposed to more than 28 days of Zidovudine was lower than the mean Hb in neonates exposed to less than 28 days in the 29-31week and over 31 week gestational age categories. The haematological side effects of anaemia in neonates resulting from AZT exposure inutero were found to be prevalent but of a mild and clinically insignificant nature in keeping with existing international and continental studies. The severity of anaemia in low birth weight/ pre-term neonates appears to be the same as in term neonates of normal birth weight depicted in these studies. The presence of neonatal anaemia at birth has been shown to be related to the duration of exposure to intrauterine AZT in one of the three age groups. There were no identified issues that would warrant amending current recommendations for the routine use of AZT for the prevention of mother-child HIV transmission however these findings require further research involving larger numbers and follow up of neonates in order to adequately analyse current PMTCT guidelines.
A follow-up study of the respiratory health status of automotive spray painters exposed to paints containing isocyanates.
(1997) Randolph, Bernard Winston.; Lalloo, Umesh Gangaram.
In order to evaluate the respiratory health status of spray painters exposed to paints containing hexamethylene diisocyanates (HDI) and to obtain more insight into the relationship between occupational exposures to isocyanates and chronic obstructive airway diseases, a follow up study on 33 of an original cohort of 40 randomly selected workers was undertaken. The original investigation was conducted by the author in 1989. The subjects were studied using a standardised American Thoracic Society (ATS) approved respiratory health questionnaire, baseline pre and post shift spirometry and ambulatory peak flow monitoring. Bronchial hyperresponsiveness tests using histamine (PC20) were performed. Immunological tests including IgE, RAST (HDI), and house dust mite evaluations were also made. The subjects were stratified into exposed (n=20), partially exposed (n=5) and no longer exposed (n=7) groups. One subject was excluded from the group analysis because of his indeterminate isocyanate exposure. Warehouse assistants (n=30) in a non-exposed occupation were used as controls. The worker's compliance with safety regulations and the employers provision of safety requirements was assessed by means of a questionnaire. The environmental conditions in the workplace were measured by the evaluation of the isocyanate concentrations at the worker's breathing zone. Spray booth efficiency was measured using measurements of airflow velocities and airflow patterns within the booth. Longitudinal changes in respiratory health status was assessed by comparison with baseline data studied in 1989. The exposed group showed the largest mean cross-shift declines of 297 ml (± 83.8) in forced expiratory volume in one second (FEV1). The decline in the partially exposed group was 282 ml (± 102.7) and 54 ml (± 140) in the no longer exposed group. The results of the first study, when compared with the second study, showed a mean cross-shift decline in FEV1 of 130.5 ml. (± 203) (p=0.0002) and 297ml. (± 323) (p=0.0001) respectively. Furthermore, of the spray painters examined, 10 (25%) showed clinically significant cross-shift declines in FEV1 viz. decreases >250 ml in the first study (n=40) compared with 9 (45%) in the second study (n=33). In contrast to the HDI exposed spray painters, a closely matched control group (n=30) showed a mean cross-shift increase in FEV1 of 17.4 ml ( ± 63.04). Only 2 subjects had a diagnosis of asthma which was made in childhood and not related to occupation. The mean annual baseline decline in FEV1 was greatest in the exposed group 41.25 ml (25% showed a decline greater than >90 ml per annum). These values exceeded the predicted annual declines for both smokers and non smokers due to age. The decline in the no longer exposed group was 7.85 ml per annum. Immunological tests showed no correlation with declines in FEV1 . This study demonstrates the difficulties in correlating immunological status with clinical and lung function findings in workers exposed to HDI, as a means of predicting occupational asthma. Although measurements in cross-shift declines in FEV1 appear to be a suitable predictor of occupational asthma, in some cases it was found that the forced expiratory flow rate (FEF 25-75 %) was a more sensitive predictor of early changes in the small airways. The mean isocyanate concentration in the spray painter's breathing zone was 14.65 mg/m3 (±12.219), exceeding the current South African Occupational Exposure Limit - Control Limit (OEL-CL) of 0.07 mg/m3 for isocyanates. Fifty per cent of the subjects suffered from eye irritation and 40% had dermatitis of the hand. This was expected since none of the spray painters wore goggles or gloves. Whilst no subject had evidence of clinical asthma related to spray painting, a large proportion demonstrated significant cross- shift changes in lung function implying short- term adverse effects of exposure. In addition longitudinal declines in lung function which was worse in those who continued spray painting in the follow-up study, is of major concern. The lack of cases of clinical or occupational asthma may be due to the healthy worker effect. Recommendations include, routine spirometric lung function testing of all spray painters, the use of high volume-low pressure spray guns and the wearing of positive pressure airline masks complying with the South African Bureau of Standards (SABS) safety standard. In terms of current legislation it was further recommended that spray booths be regularly monitored, including the measurement of HDI concentrations, airflow velocities and airflow patterns within the booth and the implementation and enforcement of stricter control measures. Workers demonstrating excessive declines in both cross-shift and longitudinal spirometry, require special attention.
Health care of the geriatric Indian population of Port Shepstone.
(1986) Naidoo, D. M.
No abstract available.
Identification of suicidal ideation in HIV-infected patients : development of a suicide risk assessment tool and a suicide intervention plan for HIV-infected patients following voluntary counselling and testing.
(2014) Govender, Romona Devi.; Schlebusch, Lourens.
ABSTRACT Background. Globally, suicide and HIV/AIDS remain two of the greatest healthcare issues, particularly in low- and middle-income countries where approximately 85% of suicides occur. Every year, more than 800,000 people die from suicide; this roughly corresponds to one death every 40 seconds, and the World Health Organization (WHO) estimates that by 2020 the rate of death will increase to one every 20 seconds. HIV/AIDS patients in South Africa have a higher suicide risk than the general population and may an increased frequency and severity of suicidal ideation depending on the different intervals in the continuum of HIV disease progression. Several studies have observed a relationship between the increase in suicide and HIV in South Africa, but due to the paucity of empirical data, this relationship remains inconclusive. Suicide in HIV-infected persons is multifactorial. Risk factors include: a history of attempted suicide; fears of social isolation; feelings of hopelessness; fear of losing control of life; elevated levels of depression; denial; and poor coping strategies. Despite the introduction of antiretroviral therapy (ART), the suicide rate remains more than three times higher among HIV-infected persons than in the general population. Although international findings on the correlation between suicide and HIV/AIDS are diverse, results show compelling evidence to screen for suicide risk and intervene as early as possible. Objectives. The main objectives of this research were: (i) to determine the prevalence of suicidal ideation in HIV-positive persons following voluntary HIV counselling and testing (VCT); (ii) to develop and validate a suicide risk screening scale (SRSS) for use in HIV-infected persons post HIV diagnosis; (iii) to implement and evaluate a brief suicide preventive intervention (BSPI) for use in the period immediately following HIV diagnosis. Methods. A quantitative methodology was used with a cross-sectional, correlational and regression analysis in the prevalence study. Participants completed a sociodemographic questionnaire, Beck’s Hopeless Scale and Beck’s Depression Inventory. Drawing 14 items from two established screening tests, the SRSS was developed and assessed. Validity, internal consistency and receiver-operating curves were used to determine the sensitivity and specificity of the tool. Following confirmation that recently diagnosed HIV-positive persons were at risk for suicidal behaviour, a BSPI was implemented and its efficacy evaluated with the validated SRSS. Statistical analysis included generalised linear modeling, and Pearson’s and McNemar’s chi-square analyses. Results. There was an increase in suicidal ideation over a six-week period following a positive HIV diagnosis, from 17.1% to 24.1%. Suicidal ideation was significantly associated with seropositivity, age and gender, with the majority of affected patients falling in the younger age category. Young males had an 1.8 times higher risk for suicidal ideation than females. Lower education and traditional beliefs were also significantly associated with an HIV-positive status upon testing. The SRSS was implemented and, despite certain limitations, was considered to be a valuable screening tool for suicidal ideation at VCT clinics. The BSPI was associated with a clinically significant decrease in the rate of suicidal ideation over time, providing preliminary evidence on its efficacy. Conclusion. Significant correlations exist between hopelessness, depression and suicidal ideation; these serve as important markers that should alert healthcare professionals to underlying suicide risks in HIV-positive patients. Screening for suicide risk and possible suicidal behaviour should form a routine aspect of comprehensive patient care at VCT clinics to assist with effective prevention and treatment. Healthcare workers at VCT clinics should be trained in suicide prevention interventions and the importance of educating vulnerable HIV-positive patients on suicide-prevention strategies. Further longitudinal studies are recommended to enable researchers to observe and differentiate between the variables that may be more prevalent at different stages of HIV, as well as the impact of ART on suicidal behaviour.
The impact of Laduma, a health education intervention, on the knowledge, attitudes, beliefs, and practices regarding sexually transmitted infections among secondary school learners in KwaZulu-Natal.
(2005) Shamagonam, James.; Jinabhai, Champaklal Chhaganlal.; Reddy, S. P.
Purpose To evaluate the impact of Laduma, a health education intervention, on the knowledge, attitudes, beliefs and practices regarding sexually transmitted infections among secondary school learners in KwaZulu-Natal. Objectives The objectives of the study were to determine knowledge, attitudes, beliefs, perceptions and practices of secondary school learners regarding sexually transmitted infections at baseline and post-exposure to Laduma; assess intended behaviour change regarding sexually transmitted infections and condom use as well as the awareness of skills to achieve such behaviour; assess learners' perceived vulnerability to sexually transmitted infections; assess comprehension, acceptability and appeal of the photonovella among learners and to assess whether learners can identify with the characters and situations in the photo-novella. Design This was an experimental study design. Setting Nineteen randomly selected secondary schools in the Midlands district of KwaZulu-Natal. Subjects Grade 11 learners, n = 1168, from randomly selected schools that were further randomised into intervention and control groups. Outcome Measures The learners had to complete three sets of questionnaires that elicited information about their biographical profile, knowledge, attitudes, beliefs, perceptions and practices regarding sexually transmitted infections, intention to change their behaviour with regard to sexually transmitted infections and condom use, as well as their skills to achieve such behaviour, their perceived vulnerability to sexually transmitted infections and their perceptions of Laduma. All of these outcomes were assessed at baseline (Tl), following the learners' exposure to Laduma (T2, three weeks after the baseline), as well as six weeks later (T3) in the case of the intervention group. With respect to the control group they had to answer the baseline questionnaire on all three occasions. Results The mean age of the respondents was 16.8 years with almost two thirds of the learners being between the ages of 15 - 18 years. Seventy percent were primarily Zulu speaking. Learners reported feeling personally scared of getting a sexually transmitted infection with 17.8% responding that they thought they could get a sexually transmitted infection in the next two years. There was a significant gender difference between male and female learners in their topics of communication to friends, parents and partners regarding HIV/AIDS, condom use, having sex or not having sex (p < 0.01). Although learners had adequate knowledge about the spread of sexually transmitted infections at baseline, the mean scores for the spread for the group exposed to Laduma differed significantly from the mean scores of the control group, both immediately after the intervention (p < 0.01) and six weeks thereafter (p < 0.001). Learners in the intervention group responded more positively towards condom use at time 2 (T2) than the control group and maintained this change six weeks later. Sexual activity and condom use at time 3 (T3) was not influenced by the intervention but was significantly predicted by past sexual activity (p< 0.001) and past condom use (p < 0.001) respectively. At time 3 (T3) significantly more learners in the intervention group intended to have sex with a condom (65.1 %) compared to the control group (52.3%, p < 0.05). Overall learners had a positive response to Laduma and appreciated it as a health education intervention. Conclusion and Recommendation The findings of this study provided important information about adolescent sexuality on a range of outcomes related to knowledge, attitudes and sexual behaviour. The findings also provided information on learners' gender differences about what they communicate and to whom, as well as their sexual behaviour. After a single reading of Laduma learners showed an increase in knowledge about the spread of sexually transmitted infections, a change in their attitude to condom use as well as an increased intention to practice safer sex. Laduma did not influence communication about sexually transmitted infections, sexual behaviour nor condom use. These are complex behaviours and indicate that interventions focussing on preventive sexual behaviour need to move beyond awareness and information dissemination towards being more intensive and skills focussed. Such interventions need to address the gaps between knowledge and practice and be facilitated in a context that supports such implementation. The specific recommendations made from the findings of this study therefore include, the development of a systematic health promotion programme that addresses the issues related to personal vulnerability, knowledge related to treatment of and protection against sexually transmitted infections as well as skills that promote safer sexual choice.
Isoenzyme polymorphism in entamoeba histolytica : an epidemiological survey in a rural South African population.
(1989) Gathiram, Vinodh.; Jackson, Terry F. H. G.; McLeod, I. N.
Isoenzyme characterisation of Entamoeba histolytica into pathogenic and non-pathogenic zymodemes substantiated previously held views that this parasite con5titutes two distinct strains or even sub-species that are morphologically identical but vary in their pathogenicity. A reappraisal of the epidemiology of amoebiasis and investigation of the patho-physiological relationships between these pathogenic and non-pathogenic zymodemes and their host was therefore indicated. Only pathogenic zymodemes were isolated from hospitalised patients with amoebic liver abscess (ALA) and amoebic dysentery (AD). In the amoebiasis endemic peri-urban population of Durban, I. histolytica occurred at an overall prevalence of 10%. Carriers of non-pathogenic zymodemes constituted 9% of the population. A key observation was that asymptomatic infections with pathogenic zymodemes occurred at a prevalence of 1%. Higher prevalence of E. histolytica occurred in association with poor sanitary conditions. Furthermore., both pathogenic and non-pathogenic zymodemes tended to cluster into family units suggesting person-to-person transmission of the parasite by the faecal-oral route. Although invasive amoebiasis occurs far more frequently in males than females (8:1) both pathogenic and non-pathogenic zymodemes are equally distributed in male and female E. histolytica cyst passers. Ninety percent of carriers of pathogenic zymodemes spontaneously cleared their infections and remained asymptomatic throughout the study period of 2 years while 10% developed AD which required treatment with metronidazole. No spontaneous changes in zymodemes from the non-pathogenicto the pathogenic type was observed in a longitudinal study. The serological response of asymptomatic carriers of pathogenic zymodemes (100% seropositive) was identical to that of patients with ALA or AD with a high proportion (94-100%) of them being strongly seropositive. The prevalence of seropositivity amongst subjects who were not infected by E. histolytica (13% seropositive) was not statistically different (p>0,5) from that of the random population of this endemic area (19% seropositive) and carriers of non-pathogenic zymodemes (21% positive); the prevalence of strongly seropositive reactions among this group was only between 2-4%. It is concluded that a positive serological response is directly due to past or present contact with pathogenic zymodemes. This is further substantiated by the observation that the proportion of seropositive subjects was found to increase dramatically in a population near Cape Town where an outbreak of invasive amoebiasis (ALA and AD) occurred indicating a high prevalence of pathogenic zymodemes in this community. Another community in northern Transvaal (Gazankulu) where ALA and AD does not occur was, as expected, uniformly seronegative. Axenic growth of pathogenic zymodemes was possible but could not be accomplished with the non-pathogenic zymodemes. Even though monaxenic growth together with Trypanosoma cruzi was possible with both strains, the pathogenic zymodemes tended to grow more prolificly. No zymodeme changes from non-pathogenic to pathogenic and vice versa were observed with such changes in culture conditions. Cyst production by the pathogenic zymodemes in vivo was confirmed experimentally, thereby demonstrating the ability of pathogenic E. histolytica to independently complete their life-cycle thus giving it the ability to propagate itself successfully as a species.
Knowledge and utililization of contraception amongst teenagers attending an urban Indian general practice.
(1991) Jugnundan, Prakash.
During the six month period June to December 1990, 300 Indian teenagers attending the urban general practice of the researcher were interviewed. Data pertaining to age, sex, knowledge and utilization of contraceptives were recorded. The results showed that the majority of teenagers (57%) had a good knowledge of contraceptives. Utilization, however remained low. Most (56%) knew where their local Family Planning Clinic was, but only a small percentage (15%) attended. Recommendations directed towards implementing increased utilization of various contraceptive methods and decreasing teenage pregnancies are submitted.
Knowledge and utilisation of contraception in Indian females attending an urban general practice.
(1995) Singh, Suriyabala Kissoon.; Naidoo, B. N.; Moodley, Jagidesa.
459 Indian female patients between the ages of 16 and 50. attending the practice of the researcher were asked to complete a confidential questionnaire on the knowledge and utilisation of contraception. The results of the study revealed that the majority of the participants were literate and possessed some knowledge of contraception. The contraceptive choice was the Pill with many participants also favouring the use of the intra uterine device. Condoms were used by only ten percent of the group while the use of the injection - Depot Provera - was negligible. Most peri menopausal women had completed their families and had undergone Tubal Ligation even though a fair number had the intra uterine device in place and also had continued using the Pill as their contraceptive.
Medical practitioners’ reactions towards family medicine as a speciality in South Africa.
(AOSIS, 2008) Naidoo, Cyril.; Esterhuizen, Tonya.; Gathiram, Premjith.
Background: Family physicians are trained to treat a wide range of diseases, treatment being centred on the patient, family and community irrespective of age, gender, or ethnic or racial background. To deal with inequalities in health care, the South African government introduced the concept of a district health system in 1997. It was only in August 2007, however, that family medicine was legislated as a speciality. This study was undertaken prior to the enactment of this legislation. Method: A descriptive quantitative study using a self-administered questionnaire was undertaken. A convenience sampling technique was used (N = 60) to assess the reactions of medical practitioners towards the impending legislation. Results: Overall, 60% of the sample was in favour of the legislation. There were no significant differences between those working in the private and public sectors or between generalists and specialists. With regard to those not in favour of the legislation compared to those in favour of the legislation, a significantly increased number answered the following statements in the affirmative: (i) ‘I already carry out the functions of a family physician’ (p = 0.001), (ii) ‘They [specialist family physicians] will not be as qualified as specialists in other categories’ (p = 0.005), (iii) ‘It will have a negative impact on general practice’ (p < 0.001), (iv) ‘It will increase competitiveness’ (p = 0.021), (v) ‘It will not have any effect on patient care’ (p = 0.010) and (vi) ‘There is no need for such a speciality’ (p = 0.001). Conclusion: We concluded that the majority were in favour of the legislation being implemented.

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